MEDICARE: MISS LAURA ELIZABETH OSOBA PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	085-005310	IL

General Provider Information

NPI Number	:	1487051579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LAURA ELIZABETH OSOBA PA-C

Provider Business Mailing Address
First Line	:	4400 W 95TH ST
Second Line	:	SUITE 205
City	:	OAK LAWN
State	:	IL
Zip	:	60453-2654
Country	:	US
Telephone Number	:	708-346-4040
Fax Number	:	708-346-3287

Provider Business Practice Location Address
First Line	:	201 E HURON ST STE 11-140
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2968
Country	:	US
Telephone Number	:	312-926-8636
Fax Number	:	312-695-1903

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2014
Last Update Date	:	03/17/2018

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